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4. Staging

4.1 The FIGO (Fédération International de Gynécologie et Obstétrique) system is the preferred staging for uterine cervix.

TNM
Categories
FIGO
Stages

TX  Primary tumour cannot be assessed
T0
  No evidence of primary tumour
Tis٭
Carcinoma in situ (preinvasive carcinoma)
T1
I
Cervical carcinoma confined to uterus (extension to corpus should be disregarded)
T1a٭٭
IA
Invasive carcinoma diagnosed only by microscopy. Stromal invasion with a maximum depth of 5 mm measured from the base of the epithelium and a horizontal spread of 7 mm or less. Vascular space involvement, venous or lymphatic, does not affect classification.
T1a1
IA1
Measured stromal invasion of 3.0mm or less in depth and 7.0mm or less in horizontal spread 
T1a2
IA2
Measured stromal invasion of more than 3.0 mm and not more  than 5.0 mm with a horizontal spread 7.0 mm or less
T1b
IB
Clinically visible lesions confined to the cervix or microscopic lesion greater than T1a/IA2. Includes all macroscopically visible lesions, even those with superficial invasion.
T1b1
IB1
Clinically visible lesion 4.0 cm or less in greatest dimension
T1b2
IB2
Clinically visible lesion more than 4.0 cm in greatest dimension
T2
II
Cervical carcinoma invading beyond the uterus but not to the pelvic wall or to lower third of the vagina
T2a
IIA
Tumour without parametrial invasion
T2a1
IIA1
Clinically visible lesion 4.0 cm or less in greatest dimension
T2a2
IIA2
Clinically visible lesion more than 4.0 cm in greatest dimension
T2b
IIB
Tumor with parametrial invasion
T3
III
Tumour extending to pelvic sidewall* and/or involving lower third of vagina and/or causing hydronephrosis or non-functioning kidney

*Pelvic sidewall is defined as the muscle, fascia, neurovascular structures and skeletal portions of the bony pelvis. On rectal examination there is no cancer free space between the tumour and the pelvic sidewall
T3a
IIIA
Tumour involving lower third of vagina but not extending to pelvic wall
T3b
IIIB
Tumour extending to pelvic wall and/or causing hydronephrosis or non-functioning kidney
T4
IVA
Tumour invading mucosa of bladder or rectum and/or extending beyond true pelvis

Note: the presence of bullous edema is not sufficient to classify a tumour as T4
TNM
Categories
FIGO
Stages

NX
 
Regional lymph nodes cannot be assessed
N0

No regional lymph node metastasis
N0(i+)

Isolated tumour cells in regional lymph nodes no greater than 0.2 mm
N1
IIIB
Regional lymph node metastasis
M0

No distant metastasis
M1
IVB
Distant metastasis (including peritoneal spread, involvement of supraclavicular, mediastinal, or paraaortic lymph nodes, lung, liver, or bone)

*FIGO no longer includes stage 0 (Tis)
٭٭All macroscopically visible lesions—even with superficial invasion—are T1b/IB.

Anatomic stage/prognostic groups (FIGO 2008)
Stage 0*
Tis
N0
M0
Stage I
T1
N0
M0
Stage IA
T1a
N0
M0
Stage IA1
T1a1
N0
M0
Stage IA2
T1a2
N0
M0
Stage IB
T1b
N0
M0
Stage IB1
T1b1
N0
M0
Stage IB2
T1b2
N0
M0
Stage II
T2
N0
M0
Stage IIA
T2a
N0
M0
Stage IIA1
T2a1
N0
M0
Stage IIA2
T2a2
N0
M0
Stage IIB
T2b
N0
M0
Stage III
T3
N0
M0
Stage IIIA
T3a
N0
M0
Stage IIIB
T3b
Any N
M0

T1-3
N1
M0
Stage IVA
T4
Any N
M0
Stage IVB
Any T
Any N
M0

4.2 Staging Diagram

Click here or the image below to view a larger version of the Cervix Staging Diagram.




4.3 Investigations for Staging

Following biopsy confirmation of carcinoma of the cervix, history and physical examination and the following staging investigations should be done:
  1. Lab studies: CBC, differential, BUN and creatinine, liver function tests and β-HCG in pre-menopausal patients, as indicated.
  2. Radiological studies: MRI pelvis and PET-CT scan. CT scan of the chest-abdomen-pelvis can be done if PET scan is not available.  PET-scan and MRI of the pelvis are standard of care before starting radiotherapy (for staging and planning purposes).
  3. Examination under anesthesia (EUA), if necessary, to assess primary tumor volume and extent.

SOURCE: 4. Staging ( )
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